Podcast Summary: Bulwark Takes - Episode 1: "Trump Wants This Bill and It’s a DISASTER For His Supporters"

Release Date: June 19, 2025
Host: The Bulwark Team (Featuring Jonathan Cohn and JVL)

Introduction

In the inaugural episode of Bulwark Takes, hosted by The Bulwark team, Jonathan Cohn and JVL delve into the ramifications of the Senate's latest legislative proposal, colloquially referred to as the "Big Beautiful Bill." The discussion centers on the bill's impact on Medicaid, the Affordable Care Act (ACA), rural hospitals, and the broader political landscape, especially concerning Republican support and upcoming elections.

Overview of the Senate's "Big Beautiful Bill"

Jonathan Cohn opens the conversation by outlining the Senate's version of the bill, highlighting its financial implications and potential consequences for government healthcare programs.

Jonathan Cohn [01:55]: "The big headline about the Senate bill is that in the big picture, it's like the House bill. It's gonna take about a trillion dollars out of government healthcare programs over the next 10 years."

The bill aims to reduce government expenditure by approximately one trillion dollars over a decade, primarily targeting Medicaid and the ACA. Cohn emphasizes that the bill is poised to adversely affect millions of Americans by potentially stripping away their health insurance or increasing their healthcare costs.

Impact on Medicaid and the Affordable Care Act

The primary focus shifts to how the bill affects Medicaid and the ACA, with Cohn detailing the projected fallout.

Jonathan Cohn [02:30]: "A lot of people are going to lose health care. We're looking at 11 million people projected to lose health insurance..."

He explains that the Senate bill, much like its House counterpart, forecasts significant reductions in funding for Medicaid and the ACA. This would result in millions losing their current healthcare coverage or facing increased premiums and out-of-pocket expenses.

Cohn also touches upon the legislative process, noting the rapid progression of the bill through the Senate without thorough debate:

Jonathan Cohn [03:43]: "The Senate has yet to debate the bill and vote on it. It could change. But if there was, you know, insofar as people were thinking, well, the Senate is going to save this bill or at least make it a lot better from the standpoint of healthcare access. No."

This rapid movement suggests a strategic push to pass the bill before public opposition solidifies.

Secondary Effects on Rural Hospitals

A significant portion of the discussion revolves around the secondary impacts of cutting Medicaid, particularly on rural hospitals.

Jonathan Cohn [05:49]: "Rural hospitals have increasingly relied on that Medicaid money to kind of save them from oblivion... The danger is you take more money out of Medicaid and now rural hospitals are in bigger trouble."

Cohn elaborates on the precarious financial state of rural hospitals, which often depend heavily on Medicaid funding. Cuts could lead to hospital closures, reduced services, and longer travel distances for emergency medical care, as exemplified by a case in southeastern Iowa where a hospital closure forced a roadside childbirth during a blinding snowstorm.

Jonathan Cohn [08:00]: "Imagine you're in a blinding snowstorm, 70 miles from the nearest hospital, needing emergency care. That's the ripple effect of these Medicaid cuts."

Political Implications and Electoral Consequences

The conversation shifts to the political fallout of the bill, particularly how it affects Republican support ahead of upcoming elections.

JVL posits that the traditional assumption—Medicaid cuts primarily affecting Democratic constituencies—no longer holds true due to shifts in the voting landscape.

JVL [09:05]: "The calculus used to be... lower income people and so probably Democratic constituents. And that is not true... It’s likely more Republicans will be hurt than Democrats."

Cohn concurs, explaining that Medicaid expansion under the ACA brought many working-class individuals, who lean Republican, into the fold. Therefore, cuts will disproportionately impact these newfound Republican voters, especially in red states that opted out of Medicaid expansion.

Jonathan Cohn [10:00]: "Medicaid expansion brought in a lot of working poor, more likely to be Republicans. Cutting Medicaid affects red states like Florida and Texas the most."

JVL questions why Republicans would pursue such a bill that seemingly undermines their own support base, suggesting internal party dynamics and political incentives tied to President Trump's agenda as potential reasons.

JVL [12:40]: "Why would the Republican Party... pass Trump's bill and not cut Medicaid because they want to take care of their people? It just means that the deficit stuff will be a little worse... Why add this?"

Cohn offers insights into the Republican motivations, citing ideological opposition to government-run healthcare and political loyalty to Trump, even at the expense of their base's welfare.

Jonathan Cohn [13:00]: "Trump wants this bill... they're putting all their baskets into this. They don't want to be on the opposite side of Trump."

He also highlights the lack of thorough understanding among some Republican legislators regarding the bill's full implications, indicating a potential disconnect within the party.

Electoral Impact and Voter Backlash

Addressing potential electoral repercussions, Cohn discusses how increased healthcare costs and reduced access may lead to voter dissatisfaction with the Republican Party.

Jonathan Cohn [17:57]: "There will be at least some repercussions... at some point, reality does still matter."

He draws parallels to the Affordable Care Act's implementation, where Democrats faced significant backlash due to rising insurance costs. Cohn anticipates a similar reaction if the current bill leads to substantial rate hikes and loss of coverage.

JVL echoes these sentiments, expressing skepticism about Republicans' ability to maintain support without addressing the tangible negative outcomes of the bill.

JVL [22:28]: "If you're a farmer in southeast Iowa... you might want to blame Trump... I hope everybody gets what they voted for."

Cohn remains cautiously pessimistic but acknowledges the unpredictability of political outcomes.

Jonathan Cohn [23:30]: "I do think that people will see that and they will be angry. They'll be looking for someone to blame."

Conclusion

The episode concludes with JVL and Cohn emphasizing the uncertainty surrounding the bill's passage and its long-term effects. They underscore the importance of public awareness and opposition to safeguard healthcare access.

JVL [24:01]: "I’m excited for the people who voted for Donald Trump to get to have that... I hope the bill passes, and I hope everybody gets what they voted for."

Cohn reiterates the potential for political shake-ups if the bill leads to widespread negative consequences, suggesting that reality could ultimately constrain political agendas.

Jonathan Cohn [24:30]: "Reality does still matter. Maybe we'll see reality intrude enough to shake politics up."

JVL wraps up by encouraging listeners to stay informed and engaged.

JVL [24:30]: "Stay tuned. We're going to be doing more stuff. Follow the channel again..."

Key Takeaways

• Financial Impact: The Senate's "Big Beautiful Bill" aims to cut approximately one trillion dollars from government healthcare programs over ten years, primarily affecting Medicaid and the ACA.

• Health Coverage: An estimated 11 million Americans may lose their health insurance, with many more facing increased premiums and out-of-pocket costs.

• Rural Hospitals: Reductions in Medicaid funding threaten the viability of rural hospitals, potentially leading to closures and reduced access to emergency medical care.

• Political Fallout: Contrary to traditional assumptions, Medicaid cuts may disproportionately affect Republican voters due to Medicaid expansion under the ACA, creating internal party conflicts and potential electoral backlash.

• Legislative Process: The bill's swift progression through the Senate raises concerns about insufficient debate and understanding of its full impact among legislators.

• Electoral Consequences: Significant negative outcomes from the bill could erode Republican support and alter the political landscape ahead of future elections.

Notable Quotes with Timestamps:

• Jonathan Cohn [01:55]: Discusses the financial scale of the bill and its primary targets.

• Jonathan Cohn [05:49]: Explains the dependence of rural hospitals on Medicaid funding.

• JVL [09:05]: Questions the traditional political calculus regarding who is affected by Medicaid cuts.

• Jonathan Cohn [13:00]: Highlights Republican allegiance to Trump's agenda over their support base's welfare.

• Jonathan Cohn [17:57]: Predicts potential political repercussions and voter backlash.

This episode provides a comprehensive analysis of the Senate's proposed healthcare bill, elucidating its multifaceted impact on healthcare access, rural medical infrastructure, and the intricate dynamics within the Republican Party. The discussion underscores the profound implications such legislation holds for millions of Americans and the broader political ramifications that may unfold in the coming years.